II. Physiology

  1. Anterior tibial tendon function
    1. Foot dorsiflexion (major function)
    2. Foot adduction
    3. Foot inversion

III. Causes

  1. Forced dorsflexion against resistance of a plantar flexed foot (eccentric stress on tibialis anterior tendon)
    1. Distance Running
    2. Soccer or football
  2. Chronic overuse in age over 45 years

IV. Signs

  1. Pain localized to the anterior ankle
  2. Palpable mass in low anterior leg if anterior tibial tendon rupture
  3. Weak foot dorsiflexion
    1. Foot drop
    2. Slapping gait

V. Differential Diagnosis

  1. Anterior Tibial Tendon Rupture
  2. Lumbar Radiculopathy
  3. Peroneal nerve palsy

VI. Complications

  1. Complete peroneal tendon rupture (more common in age >50-60 years)

VII. Management

  1. Immobilization (e.g. CAM walker boot)
    1. Start with 3 weeks of immobilization
    2. Additional 3 weeks of range of motion Exercises and immobilization (e.g. CAM Walker boot) with ambulation only
  2. Foot dorsiflexion strengthening
  3. Orthopedic referral for complete peroneal tendon rupture

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